dc.contributor.author | Raine, R | |
dc.contributor.author | Xanthopoulou, P | |
dc.contributor.author | Wallace, I | |
dc.contributor.author | Nic A' Bháird, C | |
dc.contributor.author | Lanceley, A | |
dc.contributor.author | Clarke, A | |
dc.contributor.author | Livingston, G | |
dc.contributor.author | Prentice, A | |
dc.contributor.author | Ardron, D | |
dc.contributor.author | Harris, M | |
dc.contributor.author | King, M | |
dc.contributor.author | Michie, S | |
dc.contributor.author | Blazeby, JM | |
dc.contributor.author | Austin-Parsons, N | |
dc.contributor.author | Gibbs, S | |
dc.contributor.author | Barber, J | |
dc.date.accessioned | 2016-05-04T14:44:04Z | |
dc.date.issued | 2014-10 | |
dc.description.abstract | OBJECTIVE: Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. METHODS: We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. RESULTS: The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). CONCLUSIONS: Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care. | en_GB |
dc.description.sponsorship | This project was funded by the NIHR Health Services
and Delivery Research programme (project number 09/2001/
04) and will be published in full in the Health Services and
Delivery Research Journal. Further information available at:
(http://www.netscc.ac.uk/hsdr/projdetails.php?ref=09-2001-04).
In accordance with NIHR regulations, the findings reported
here are to be referred to as initial until the NIHR final report
has been published. The sponsors of the study had no role in
study design, data collection, data analysis, data interpretation,
the writing of the report, or the decision to submit the report
for publication. | en_GB |
dc.identifier.citation | Vol. 23, pp. 867 - 876 | en_GB |
dc.identifier.doi | 10.1136/bmjqs-2014-002818 | |
dc.identifier.other | bmjqs-2014-002818 | |
dc.identifier.uri | http://hdl.handle.net/10871/21378 | |
dc.language.iso | en | en_GB |
dc.publisher | BMJ Publishing Group | en_GB |
dc.relation.url | http://www.ncbi.nlm.nih.gov/pubmed/24915539 | en_GB |
dc.rights | This is an Open Access article distributed in
accordance with the Creative Commons Attribution Non
Commercial (CC BY-NC 3.0) license, which permits others to
distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided
the original work is properly cited and the use is noncommercial.
See: http://creativecommons.org/licenses/by-nc/3.0/ | en_GB |
dc.subject | Chronic Disease Management | en_GB |
dc.subject | Decision Making | en_GB |
dc.subject | Health Services Research | en_GB |
dc.subject | Teams | en_GB |
dc.subject | Teamwork | en_GB |
dc.title | Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study. | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2016-05-04T14:44:04Z | |
dc.identifier.issn | 2044-5415 | |
exeter.place-of-publication | England | |
dc.description | This is the final version of the article. Available from the publisher via the DOI in this record. | en_GB |
dc.identifier.journal | BMJ Quality and Safety | en_GB |
dc.identifier.pmid | 24915539 | |